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D.C. Municipal Regulations (Last Updated: September 13, 2017) |
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Title 22. HEALTH |
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SubTilte 22-B. PUBLIC HEALTH AND MEDICINE |
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Chapter 22-B55. STANDARDS FOR PREPAID PROVIDERS QUALIFYING TO SERVE DISTRICT OF COLUMBIA MEDICAID RECIPIENTS |
Section 22-B5507. SERVICE DELIVERY AND QUALITY ASSURANCE PROVISIONS
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5507.1 The QO shall provide each enrollee with health care of consistent quality, delivered with dignity, at locations which assure reasonable availability and accessibility to enrollees.
5507.2 The QO shall provide, or arrange through subcontractors for the provision of each service in the benefit package.
5507.3 The QO shall assure that emergency medical care is available on a twenty-four (24) hour basis, seven (7) days a week, either in the QO’s own facilities or through other appropriate facilities.
5507.4 Each Medicaid enrollee of a QO shall receive service through the same providers and facilities serving non-Medicaid enrollees.
5507.5 Each Medicaid enrollee shall be fully integrated into plan membership and shall not be treated differently than a non-Medicaid enrollee.
5507.6 The QO shall allow each enrollee, to the maximum extent feasible, the freedom to choose among its participating providers for primary health care.
5507.7 The QO shall provide health education programs for its enrollees in languages understood by the population being served, that at least include the following items:
(a)Information on available preventive care and its value;
(b)Information on dangers of teenage pregnancies and the importance of prenatal care and well baby care; and
(c)Information on drug abuse and alcoholism.
5507.8 The QO shall have a system for follow-up of patient care for enrollees with chronic and acute illnesses, including an appointment follow-up system for “no-shows.”
5507.9 Waiting times for appointment shall not exceed those of non-Medicaid members.
5507.10 The QO shall maintain adequate medical records on each enrollee.
5507.11 The QO shall establish and maintain a quality assurance program, approved by the Department, to review the quality, appropriateness and timeliness of the services performed.
5507.12 The quality assurance program shall meet at least the following requirements:
(a)Be consistent with federal Medicaid utilization control regulations;
(b)Provide for review by appropriate health care professionals of the process followed in providing health services; and
(c)Provide for systematic data collection of performance and patient results.